The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke

Fröhlich K, Siedler G, Stoll S, Macha K, Kinfe TM, Dörfler A, Eisenhut F, Engelhorn T, Hölter P, Lang S, Mühlen I, Schmidt M, Kallmünzer B, Schwab S, Seifert F, Winder K, Knott M (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Neuroradiology Springer Verlag (Germany)

DOI: 10.1007/s00234-021-02762-3

Abstract

Purpose Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician's decision between GA and CS using voxel-based lesion symptom mapping (VLSM). Methods In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test. Results One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group. Conclusions The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician's decision on using GA in EVT.

Authors with CRIS profile

Kilian Fröhlich Department of Neurology Gabriela Siedler Department of Neurology Svenja Kremer Department of Neurology Kosmas Macha Department of Neurology Thomas Mehari Kinfe Professur für Neurochirurgie mit dem Schwerpunkt Funktionelle Stereotaktische Neurochirurgie Arnd Dörfler Department of Neuroradiology Felix Eisenhut Department of Neuroradiology Tobias Martin Engelhorn Department of Neuroradiology Philip Hölter Department of Neuroradiology Stefan Lang Department of Neuroradiology Iris Mühlen Department of Neuroradiology Manuel Schmidt Department of Neuroradiology Bernd Kallmünzer Department of Neurology Stefan Schwab Lehrstuhl für Neurologie Frank Seifert Lehrstuhl für Neurologie Klemens Winder Department of Neurology Michael Knott Medizinische Fakultät

How to cite

APA:

Fröhlich, K., Siedler, G., Stoll, S., Macha, K., Kinfe, T.M., Dörfler, A.,... Knott, M. (2021). The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke. Neuroradiology. https://dx.doi.org/10.1007/s00234-021-02762-3

MLA:

Fröhlich, Kilian, et al. "The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke." Neuroradiology (2021).

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